This is the Medicare EZ as Pie show. I am your host, Stephanie Garcia-Hagen. I am the co-owner of Mesa Benefits along with my husband, Bruce Hagen, who has joined me in studio today.
Welcome to the show, Bruce.
We are going to talk today about Mesa Benefits and about a subject that we get asked a lot of questions about – diabetes management in Medicare.
We are an insurance agency that focuses on Medicare Insurance. We love helping beneficiaries find the insurance that fits their lifestyle, budget and health situation. We also teach, train and mentor agents and agencies do the same.
We slice the entire Medicare system and the insurance that complements it into 4 slices of pie every week. The Medicare system is one of the most complicated parts of the retirement journey. We equate the process to discover the insurance associated with your Medicare to the process of baking a pie. The tongue in cheek title of the show is an au mage to the fact that
sometimes things are complicated. When that is true, it is important to find someone who has honed their skills and can break that process down for you to make it EZ as pie.
We are going to talk about Diabetes today and if you have diabetes, pie is possibly a once in a while treat. But, we here at Mesa Benefits would love for you to have a weekly treat in the Medicare EZ as Pie show.
Before we dig into today’s pie, let me give you the ways to get in touch with Bruce or me. We can be reached at 970-549-0410 or on the web at mesabenefits.com
Let’s dig in to Slice of the Pie #1 – How does diabetes work with Medicare?
A diabetes diagnosis is a life-changer. Depending on the type and level of Diabetes you’ve been diagnosed with, you get to make changes to your daily life. Whether that’s diet changes or the fact that you will have to take medications that may include learning how to give yourself an injection. Let’s don’t even mention the fact that you will be checking your blood on a regular basis.
Let’s start with Diabetes screenings. Medicare Part B covers blood glucose laboratory
screenings. There are 2 types of tests one that includes a carbohydrate challenge and one that doesn’t. If you doctor believes that you are at risk for developing diabetes, you will be covered for 2 screenings per year. How does the doctor determine if you are at risk for developing diabetes? There are several factors. If you have any of the following risk factors:
Hypertension
History of abnormal cholesterol or triglyceride levels
Obesity
History of elevated blood sugar
If you have 2 of the following risk factors, Medicare part B will cover the screening:
You’re overweight
You’re 65 or over
You have a family history of diabetes
You have a history of gestational diabetes which affects pregnant mothers for the duration of their pregnancy or delivery of a baby weighing more than 9 pounds.
These screenings are no cost to you in Original Medicare if the provider accepts Medicare
Assignment. That means that the doctor or provider accepts the maximum allowable fee from Medicare as payment in full.
There is also a diabetes prevention program that is covered by your Medicare Insurance. It’s a proven program that develops lifestyle changes that aims to prevent Type 2 Diabetes. There are coaches to help you. There are 6 monthly follow-ups that can be scheduled and even an opportunity to add additional follow-ups if a person is meeting some weight-loss goals.
Let’s move on to Slice of the Pie #2 – Are there other services available to a beneficiary that has been diagnosed with Diabetes?
The first one that comes to mind is the eye exam that screens for diabetic retinopathy. This screening is covered by your Medicare Part B. In Original Medicare, the cost for the exam is subject to the deductible and then you pay 20% of the cost of the exam. If you have a Medicare Advantage plan, there may or may not be a copay for this screening. It is important to contact your agent to see what that exam will cost.
I think this is a good time to tell you how you can reach Mesa Benefits to answer these questions for you. Bruce or I can be reached at 970-549-0410 or you can search us on the web at mesabenefits.com.
Another service that is not a screening is Diabetic Foot Care. Did you know that diabetics taking care of their feet is a crucial preventative measure to overall health. If you take care of your
feet, you will have a professional set of eyes on your limbs so that diabetic issues will be solved before they become serious.
Let’s move on to Slice of the Pie #2 – How do I access the supplies that I need in order to manage my diabetes.
Diabetes supplies are part of your Part B coverage. They are covered under your Durable
Medical Equipment coverage. We in this business really love an acronym. This coverage is your DME coverage. When we talk about these supplies, we are talking about test strips, monitoring devices and meters, insulin pumps and other things like it.
Let’s go off on a bit of a tangent.
When we are talking Medicare, the durable medical equipment supplier has to accept Medicare assignment. That term means that they are willing to accept the Medicare payment as payment in full. If you have a Medicare Advantage plan, is the DME provider in the network?
Did you know that Medicare covers custom-molded shoes or inserts? One pair every year. They are part of your Part B coverage as well. If you have original Medicare, these supplies are subject to your Part B deductible and then you are subject to the 20% coinsurance. If you have a Medicare Advantage plan, you should check to make sure that they are covered by your in-network DME supplier.
One of the biggest questions that we get when looking at diabetes management when speaking with beneficiaries is whether Continuous Glucose Monitors are covered. The first thing we say is that once the doctor determines that you meet all of the coverage requirements; which include the need to frequently check your blood sugar levels (4 or more times per day) or you use an insulin pump or get 3 or more insulin injections per day. The other requirement is that you need to make frequent in-person visits to your doctor.
Let’s move on to Slice of the Pie #3 – Insulin
Insulin is the current hot topic relative to Part D Prescription Drug coverage. There has been recent legislation that caps the cost of each Part D and Part B covered insulin to a $35 copay. Another important mention here is that under Part D, the $35 applies to everyone that takes insulin, even if you have Extra Help.
Let’s talk about the parts of Medicare that Insulin is covered under. If your insulin is delivered to your body through an insulin pump, your insulin is covered under Part B. The $35 cap I just mentioned is part of that coverage. If you do not use an insulin pump, your insulin is covered under Part D. The other supplies that are covered under Part D are syringes, gauze, and alcohol swabs. And of course the injectable insulin is covered under Part D. Interestingly, insulin that is used with a disposable pump is covered under Part D, not Part B.
If you have Part B and a medigap or Medicare supplement plan that pays your Part B coinsurance, your plan will cover the $35 cost of the insulin if you are a person that utilizes Part B for their insulin as mentioned a minute ago.
Notice I said that the $35 copay is for Part D and Part B covered insulins. What does that mean, covered? These drugs are part of a formulary. Each insurance carrier has a different formulary. One insurance company may carry your particular insulin where another one may carry another similar insulin. It is very important that you check your drug coverage every year. I cannot
emphasize this point enough. There are so many nuances with covered drugs and their costs, we get to go over them every year.
That brings us to Slice of the Pie #4 for today. Reviewing your coverage.
I say all the time that we get to review coverages every year. I think that this year with all of the legislative changes that are becoming effective in 2024, it is very important to check your coverages this year. Especially drug coverage. If you have a medigap plan with a stand-alone drug plan, we need to check your drugs against the drug plan. If you have a Medicare Advantage plan that includes prescription drug coverage, we need to check your medications against the formulary in the plan. There may be a need for a change this year. You may need to make changes for a variety of reasons. One could be that the premium on your plan increased but your usage did not change. Is there an option out there that is less money per month with equivalent coverage? Maybe. Another reason that a change could be necessary is because of a formulary change. Or a drug may be in a different tier for the coming year and you would be paying more than this year. All of these things are factors that we get to look at. You have 1 opportunity to change your prescription drug coverage per year and that is in the Annual Election Period from October 15th through December 7th. We get that period of time to go over things with you. If you have done this annual comparison on your own up until now, I highly suggest that you let an insurance advisor help you this year. There are a lot of changes and we have insights into those changes.
Bruce or I can be reached at 970-549-0410 or on the web at mesabenefits.com. We are here to be your guide through the Medicare insurance process.
Thank you so much for listening to the Medicare EZ as Pie Show. Bruce and I love slicing the Medicare Pie into 4 easy to digest slices every week. Please go to Facebook and give us a like. We love getting to know people on that platform. You’ll see when the show replay is released every week as well as other fun things that we are doing in the community.
This is the Medicare EZ as Pie show. I am your host, Stephanie Garcia-Hagen.
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